仆少多疾病。薄弱无能。遂究心于医。以求卫生之道。无如质性鲁愚。医理深奥。会
将仲景伤寒。反复研求。不得其旨。用旁索诸家之书。以求其理。惟准绳汇集诸贤之大成。非操明敏之资。
不能溯流穷源。余皆独抒所见。别开径窦。不无与圣训相悖谬。徒滋心中之蛊惑。迨观方中行之条辨。
喻嘉言之尚论。虽彼此互异。均可谓独出新裁。发明古训。至扫叔和之伪。明仲景之真。不使鱼目溷珠。
乱玉。非嘉言慧眼灵心。谁能及此。更阅柯韵伯之来苏集。王晋三之古方注。尤能得仲景之深心。重开生面。
故其发明方义。两贤如出一揆。至若辨六日传经之妄。辟三方鼎立之谬。改服麻桂于太阳未衄之前。移
系白散于太阴误下之后。千古疑团。一朝打破。又谓。仲景伤寒。已兼六气。六经主病。已该杂症。非专
指伤寒立言。柯氏以前。孰能指出厥旨。金刘河间。叔季人也。扰攘之世。炎火统运。见仲景伤寒。每详于寒
而略于温。特着医书四种。其直格一书。每多发明温热之理。惜杂于正伤寒内。在乎明眼择取。厥后绀珠一书。
亦宗河间之法。但以双解散用代麻黄桂枝等汤。以
治伤寒。则竟以伤寒为温热矣。不知仲景麻黄桂枝等汤。原治伤寒。河间双解通圣等法。原治温热。两
不相侔。不可移易。一经倒施。祸如反掌。嗟乎。寒温之别。判若天洲。寒温之治。反如冰炭。何朦混若此。
赖周禹载薛生白诸先生出。见世之伤寒正病绝少。类症殊多。寒症绝少。热病殊多。恐人误以伤寒正
法施治。乃作温热暑疫全书济世。夫温热暑疫。皆热病也。其云伤寒。自表达里。温热自内发外。温病发
于少阳。热病发于阳明。仲景黄芩汤治少阳温病。白虎汤治阳明热病。并非伤寒之方。此真发前人所未发。
其觉迷救世之功。诚非浅鲜。近又出伤寒第一书。云仲景伤寒。治分九州。此书专主扬州分野。虽其说不足
凭信。然观其用药。远热投凉。以透 解毒为主。亦治温热之良法也。第求其六淫之治。未免寡陋。独
叶天士先生所留治案。每寓伤寒于六气之中。妙法精义。无不毕备。其云仲景伤寒。先分六经。河间
温热。须究三焦。此即先生分治寒温之大法。明示人不可以足经之药。混治手经之病。只此二语。已得伤寒
之肯綮。奈世人不察。反憾叶案无伤寒。甚矣。伤寒之难明也。仆自矜管窥之见。一割之能。述六经本病
一卷。变病类病一卷。先古法。次新法。古法悉本准绳金鉴选注来苏集之注释。新法则参叶案第一书温热
全书之治焉。书成。非敢出而问世。姑存之。以就有道之政云尔。
时嘉庆元年仲秋吉日苕南吴贞坤安氏识。
我年少时多病，身体虚弱无能，于是潜心钻研医学，以求养生之道。无奈天资愚钝，医理深奥，虽然将张仲景的《伤寒论》反复研读探究，却未能领会其精髓。于是广泛搜求各家著作，以探求其中的道理。只有李中梓的《医宗必读》（注：原文“准绳”指李中梓或喻嘉言所引之集大成者，此处依语境及后文“汇集诸贤之大成”，通常指代综合性的权威著作，结合清代背景及吴坤安自述，此处“准绳”可能借指《医宗金鉴》或李中梓《医宗必读》等集大成之作，但严格按字面翻译为“准绳”类著作，即汇集众家精华之书）汇集了各位贤者的学术大成，若非具有敏锐聪慧的天资，不能追溯源头、穷尽本源。其余各家大多独自抒发见解，另辟蹊径，难免与圣人的训诫相违背谬误，徒然增加心中的困惑。等到阅读了方有执的《伤寒论条辨》和喻嘉言的《尚论篇》，虽然彼此观点互异，但都可以称为独出新裁，阐发古人的训诫。至于扫除王叔和伪托的内容，阐明张仲景的真意，不让鱼目混珠、扰乱玉石，如果不是喻嘉言拥有慧眼灵心，谁能达到这种境界？
又阅读了柯琴的《伤寒来苏集》和王晋三的《古方选注》，尤其能领悟张仲景的深意，重新开创局面。所以他们对方义的阐发，两位贤者如出一辙。至于辨析六日传经说的荒谬，驳斥三方鼎立说的错误，修改在太阳病未衄血之前服用麻黄汤、桂枝汤的规定，将白散的使用移至太阴病误下之后，千古疑团，一朝打破。又说，张仲景的《伤寒论》已经兼括六气，六经主病已经包含杂症，并非专门针对伤寒立论。在柯氏之前，谁能指出这一主旨？
金代的刘完素是末世之人，处于动荡乱世，火运当令。他看到张仲景的《伤寒论》往往详于寒而略于温，特意撰写了四种医书。其中《直格》一书，多有阐发温热理论的地方，可惜混杂在正伤寒之中，需要明眼人加以选取。此后出现的《原机启微》（注：原文“绀珠”可能指代刘河间或其学派的相关著作，如《素问玄机原病式》等，此处依原文“绀珠”直译或指代相关温热专著，鉴于刘河间代表作多为《素问》注解，此处保留“绀珠”所指代的具体书籍概念，若特指某书则译为该书名，若无特定对应，译为“绀珠一书”）也遵循刘河间的法度，只是用双解散代替麻黄汤、桂枝汤等方剂来治疗伤寒，这竟然把伤寒当作温热病了。不知道张仲景的麻黄汤、桂枝汤等方剂，原本就是治疗伤寒的；刘河间的双解散、通圣散等方法，原本就是治疗温热的。两者不相等同，不可随意替换。一旦颠倒施用，祸患如反掌之间。唉！寒证与温病的区别，判若天地之差；寒证与温病的治疗方法，相反如同冰炭。为何如此混淆不清？
幸亏周禹载、薛生白诸位先生出现，他们看到世上的真正伤寒病极少，类似症状的病很多；真正的寒症极少，热病极多。担心人们误用治疗伤寒的正法去施治，于是撰写《温热暑疫全书》以济世救人。夫温热暑疫，都是热病。所谓伤寒，是从表入里；温热则是从内发外。温病发于少阳，热病发于阳明。张仲景的黄芩汤治疗少阳温病，白虎汤治疗阳明热病，这些并不是治疗伤寒的方剂。这真是阐发了前人未曾阐发的道理，其觉悟迷途、拯救世人的功劳，确实不小。
最近又出了一本关于伤寒的第一流书籍，说张仲景的伤寒治疗分为九州分野，这本书专门主张扬州的分野。虽然这种说法不足为信，但观察其用药，远离热邪、投用凉药，以透疹解毒为主，也是治疗温热的良法。只是寻求其对六淫邪气的治疗方法，未免显得见识浅陋。唯独叶天士先生所留下的医案，每每将伤寒融入六气之中，妙法精义，无不具备。他说：“张仲景的伤寒，先分六经；刘河间的温热，须究三焦。”这就是先生区分治疗寒温的大法，明示人们不可以用足经的药物，混淆治疗手经的疾病。仅这两句话，就已经抓住了伤寒的关键。无奈世人不明察，反而遗憾叶氏医案中缺乏伤寒内容，唉，伤寒之难明啊！
我自夸管窥之见、一割之能，撰写了《六经本病》一卷，《变病类病》一卷。先列古法，次列新法。古法完全依据《医宗金鉴》、《来苏集》的注释；新法则参考叶氏医案、《伤寒第一书》、《温热全书》的治疗法则。书成之后，不敢拿出来问世，暂且保存它，以供有道之士指正罢了。
时值嘉庆元年仲秋吉日，苕南吴贞坤安识。
In my youth, I suffered from frequent illnesses and was physically weak and incompetent. Consequently, I devoted myself to the study of medicine in pursuit of the way to preserve health. Alas, my nature was dull and foolish, and medical principles were profound and abstruse. Although I repeatedly studied and sought to understand Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), I failed to grasp its essence. Therefore, I extensively searched for books by various schools to seek their underlying logic. Only Li Zhongzi's *Yi Zong Bi Du* (Essential Readings for Medical Practitioners) [Note: "Zhunsheng" refers to a comprehensive work collecting the achievements of sages] synthesized the great achievements of various sages; without a sharp and intelligent mind, one cannot trace the source to its origin. The rest mostly expressed individual views and opened new paths, inevitably contradicting the sage's teachings and merely causing confusion in the heart. Later, upon reading Fang Youzhi's *Shanghan Lun Tiaobian* (Clarifications on the Treatise on Cold Damage) and Yu Jiayan's *Shanglun Pian* (Discourse on Ancient Principles), although their views differed, both could be said to have innovated uniquely and elucidated ancient teachings. As for clearing away Wang Shuhe's apocryphal content and clarifying Zhang Zhongjing's true intent, preventing fish eyes from confusing pearls and disrupting jade, who else but Yu Jiayan with his wise eyes and spiritual mind could achieve this?
Furthermore, reading Ke Qin's *Shanghan Laisu Ji* (Commentary on the Treatise on Cold Damage) and Wang Jinshan's *Gufang Xuzhu* (Annotations on Ancient Formulas), they particularly grasped Zhang Zhongjing's deep intent and re-opened new horizons. Thus, their elucidation of formula meanings was consistent between the two sages. Regarding the refutation of the absurdity of transmission over six days and the fallacy of the tripartite division, modifying the administration of Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) before Taiyang disease manifests with epistaxis, and shifting the application of Baisan (White Powder) to after erroneous purgation in Taiyin disease, these千古疑团 (ancient mysteries) were broken in a day. It is also stated that Zhang Zhongjing's *Shanghan Lun* already encompasses the Six Qi (Six Climatic Factors), and the diseases of the Six Channels already include miscellaneous diseases, not speaking exclusively of cold damage. Before Ke Qin, who could have pointed out this purport?
Liu Wansu of the Jin Dynasty was a man of the declining era, living in a turbulent world where Fire was the dominant climate. Observing that Zhang Zhongjing's *Shanghan Lun* detailed cold but neglected warmth, he specifically authored four medical books. His book *Zhige* (Direct Grid) often elucidated the principles of warm-heat, unfortunately mixed within the context of proper cold damage, requiring discernment by clear-eyed practitioners. Later, the book *Ganzhu* (Crimson Pearl) also followed Liu Wansu's methods, but substituted Shuangjie San (Double Resolution Powder) for Mahuang Tang and Guizhi Tang to treat cold damage, effectively treating cold damage as warm-heat. This ignores that Zhang Zhongjing's Mahuang Tang and Guizhi Tang originally treated cold damage, while Liu Wansu's Shuangjie Tongsheng methods originally treated warm-heat. The two are not equivalent and should not be interchanged. Once reversed, disaster follows like turning a palm. Alas! The distinction between cold and warm-heat is as different as heaven and earth; their treatments are opposite as ice and charcoal. How can such confusion exist?
Fortunately, Mr. Zhou Yuzai and Mr. Xue Shengbai emerged. They observed that true cold damage cases were rare in the world, while similar symptoms were numerous; true cold syndromes were rare, while heat diseases were abundant. Fearing people would mistakenly apply the orthodox treatment for cold damage, they wrote *Wenre Shuyi Quan Shu* (Complete Book on Warmth, Heat, Summer-Heat, and Epidemic Diseases) to benefit the world. Warmth, heat, summer-heat, and epidemics are all heat diseases. Cold damage proceeds from exterior to interior; warm-heat emerges from interior to exterior. Wenbing (Warm Disease) originates in Shaoyang, and Rebing (Heat Disease) originates in Yangming. Zhang Zhongjing's Huangqin Tang (Scutellaria Decoction) treats Shaoyang warm disease, and Baihu Tang (White Tiger Decoction) treats Yangming heat disease; these are not formulas for cold damage. This truly elucidated what predecessors had not revealed, and his merit in awakening the deluded and saving the world is indeed significant.
Recently, a premier book on cold damage appeared, stating that Zhang Zhongjing's treatment of cold damage is divided into nine provinces, and this book specifically advocates the Yangzhou region. Although this theory is unreliable, observing its medication, it avoids heat and uses cooling agents, focusing on venting and detoxification, which is also a good method for treating warm-heat. However, its approach to the Six Excesses (Six Pathogenic Factors) seems limited. Only the medical cases left by Mr. Ye Tianshi embed cold damage within the Six Qi, containing all subtle methods and profound principles. He stated: "Zhang Zhongjing's cold damage first distinguishes the Six Channels; Liu Wansu's warm-heat must investigate the Triple Burner." This is Mr. Ye's major method for distinguishing and treating cold and warm-heat, explicitly showing that one cannot mix foot meridian medicines to treat hand meridian diseases. These two sentences alone capture the crux of cold damage. Yet, worldly people fail to observe this and instead complain that Ye's cases lack cold damage. Indeed, cold damage is difficult to clarify!
I, boasting of my limited insight and minor skill, composed one volume of *Liujing Benbing* (Original Diseases of the Six Channels) and one volume of *Bianbing Leibing* (Classified Miscellaneous Diseases). I listed ancient methods first, then new methods. The ancient methods completely follow the annotations of *Yizong Jinjian* (Golden Mirror of Medicine) and *Laisu Ji*, while the new methods reference Ye's cases, *Shanghan Diyi Shu*, and *Wenre Quan Shu*. Upon completion, I dare not publish it to the world, but keep it temporarily for correction by those with the Way.
On an auspicious day in mid-autumn of the first year of Jiaqing, Wu Zhen Kun'an of Taonan recorded this.